MEDICARE: MS. AMANDA MARIE PEREZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05453600	NJ

General Provider Information

NPI Number	:	1437461324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA MARIE PEREZ LCSW

Provider Business Mailing Address
First Line	:	163 RIDGE RD APT B
Second Line	:
City	:	CEDAR GROVE
State	:	NJ
Zip	:	07009-2058
Country	:	US
Telephone Number	:	862-305-0590
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 UPPER MONTCLAIR PLZ STE 24
Second Line	:
City	:	UPPER MONTCLAIR
State	:	NJ
Zip	:	07043-1340
Country	:	US
Telephone Number	:	862-305-0590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	11/05/2019

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